Triage Two-Step

At some point on Sunday, just one day after being released from Hospital X, I returned to Hospital X's emergency room entrance. My wife quickly procured a wheelchair and either wheeled me inside or had me wheeled inside; I'm not quite sure which. In either case, my job from that point on was simply to sit in the wheelchair, hold onto my walking cane, and wait to be called back for triage.

Around 30 minutes passed, according to my wife, and I had yet to be seen by any of the ER staff. I realized at that point that I was going to have to use the restroom if the wait stretched out any longer, so my wife wheeled me over to the nearest one. The bathrooms near the ER at Hospital X are of the unisex one-person-at-a-time type, and I learned by trying to open the door that the one I wound up at was in use and its door was locked at the time.

I remember my wife saying, "It's locked," followed by the sensation that she had moved me slightly away from the door. For some reason that I do *not* remember, I felt the need to get out of the wheelchair and try the door handle again. I stood up with the help of my walking cane, determined once more that the door really was locked, and then turned away with the intent to move out of the path of the current restroom occupant once they were finished with their business.

Now, if you've ever experienced the sensation of blacking out while still being aware of things that area going on, you might partially understand how I felt in the seconds that followed. However, you'd also have to understand what a tree probably feels and hears when two of its major branches break off in order to fully comprehend how I felt. In any case, my vision suddenly went to black and I had a sensation of falling, accompanied by the *feeling* of a snapping, cracking sound moving through my body to my ears.

The next thing I remember is being on the ground and hearing my wife gasp in horror:

"Oh my god! His ankle's broken!"

Close, but not exactly right. Both of my ankles were broken.

I had apparently slumped against a wall behind me and fell, just like a tree, to my left. As I fell, both ankles snapped as if my shoes had been glued to the floor. Unfortunately, neither my wife nor anyone else saw exactly what caused me to fall, so no one really knows if I passed out and fell on my own or was knocked over by the man and his 4-year-or-so-old daughter who had exited the bathroom as I was turning away.

I passed out before I could hear my wife yell at the man to hurry and get help. I regained consciousness only long enough to hear a nurse call, "Rapid response to ER...Rapid Response to ER," over the hospital intercom, then blacked out again until someone started moving me around. I remember knowing that I was in intense pain at the time, but my mind had disconnected itself from the sensation to the point where I don't remember what the pain felt like. My wife tells me that I'm lucky on this point.

During another brief moment of consciousness, I recall being moved onto a body board. I also remember someone cutting off my pants so that they could get to my legs for an examination. I somehow gathered up enough brainpower to crack a joke about needing to go shopping for new pants again, since they were cutting off a pair I'd just purchased a few days earlier.

The last sequence of events I remember in the hallway began with a nurse telling a doctor that my blood pressure was 60 over 20. Normal blood pressure is usually near 120 over 70, so 60/20 meant I was losing blood, and losing it badly somewhere. The doctor got her to re-check, and she still came up with 60/20. He thought for a second and then flew into action, ordering up IVs of fluids and blood.  When the nurse asked what flow rate she should use, he told her to "flood" me since I was obviously running several pints low.

I have no memory of what happened from this point until I woke up in the Intensive Care Unit. Again, my wife tells me I'm lucky and that she has no intention of refreshing my memory on the matter. She *did* take a photo of my badly broken ankles while in the ER, though. When a nurse asked her why she did that, she said that I would want to see what they looked like.

Damned right. Anything that would cause as much trouble as they would absolutely required documentation.

Bloody Confusing

I've had several operations/procedures done on me in the past that were either outpatient or involved single-day hospital stays. Every one of them has given me trouble in the days following the procedure. As I mentioned earlier, I have problems with some sedatives and anaesthetics surpressing my breathing reflex, and on occasion the effect has lasted for days after the procedure. (Try sleeping when you have to consciously remind yourself to breathe at times - that's what it's like.)

Other procedures have left me feeling like I've been buried under a pile of a dozen wet blankets. I have a hard time staying awake for any length of time and can't get up, turn over, or do any kind of moving easily. At least I don't have to concentrate on breathing when facing this type of post-op discomfort.

The gastric bypass left me feeling closer to the dozen wet blanket side of things, but without the problems of being unable to get up or move. I had trouble waking up, but when I did attain consciousness, I could get up and move around if I needed to do so.  After I had gotten over the problem with the lemon-flavored pain medicine (see previous update), I was actually pleasantly surprised with the degree of mobility I had.

(Note:  Here comes the part I warned you about at the end of the last update.  Skip to the next update unless you want the dirty details, which are provided in generous quantity below.)

One other particular problem I've had with gastrointestinal procedures is post-op constipation. Sometimes it's taken me a week after surgery before I have been able to have a bowel movement. At worst it's taken almost three weeks, as was the case when my appendix was removed back in 1983.  It's never a comfortable affair, regardless of the duration, and finally passing a stool can be more painful than the period of constipation had been.

Things were very different this time. I actually needed to go to the bathroom, not too long after arriving home. I remember being rather surprised that I was actually able to have a bowel movememtn so soon after having a major gastric operation. However, I also remember having a hard time staying awake while sitting on the toilet. I did nod off a few times, but I always caught myself before suffering the humiliation of falling off the throne in mid-dump.

I had several bowel movements between Saturday evening and Sunday and continued to be somewhat surprised that I was going.  However, in retrospect I should have instead been worried about what was happening inside of me.  Each movement involved black, tarry stools, something I'd never experienced before but had certainly heard of. Black, tarry stools mean that blood is coming out of one's body by way of the intestines, but since I'd just had a major stomach operation I figured I was just passing blood that had entered my GI tract during surgery. My wife thought the same, but at the same time she was concerned about a "funny smell" (her words) that hung around after each bowel movement despite the best efforts of the bathroom vent fan to clear the air.

My wife tells me she started getting really concerned towards Sunday noon when she began having more and more trouble getting me to wake up for pain medicine doses and other things like eating popsicles and so on. As mentioned earlier, I'd had problems waking up in after surgery in the past and wasn't very concerned about this myself, but my wife said this time was worse that any she'd dealt with during my previous recoveries. She says the situation eventually got so bad that she decided to call the surgeon's office (I don't honestly know if she talked to a nurse or the doctor himself) and tell them that she was having trouble waking me up. She told them that I was "lethargic and unresponsive," and expressed her concerns about the "funny smell" after bowel movements to them.  She says the person on the other end of the phone didn't seem very worried and didn't even give a "hmmm..." to the funny smell issue.

The doctor's office gave her two options: either bring me in to the office on Monday, or take me to the Emergency Room now if she thought I was really that bad off. She chose the latter. Again in retrospect, if she'd waited until Monday you'd probably be reading an obituary instead of this blog, so despite what happened later that day in the ER, her actions likely saved my life.
 
(To be continued...)

Trouble In Stealth Mode

One uneventful trip home later and I'm sitting on our sofa with my right side pretty much propped up by the arm cushion and my head leaning back with my face pointed at the ceiling. I'm feeling very groggy and am occasionally falling asleep sitting up. No serious nausea, though, and fortunately no apparent problems with my breathing reflex.

My wife left to get my pain medicine prescription filled, which turned out to be a much more difficult task than you would imagine (partly my fault). The scrip was for hydrocodone elixir (i.e., liquid), so I asked her if she'd get the pharmacist to put a flavor in it to help it go down a bit easier. I was thinking grape or cherry, but I didn't have the wits about me to mention either of these. In short, I left the flavor choice up to her, and for some unknown reason she decided that lemon would be good for a person who has just had his stomach rearranged. So, she asked for and brought home lemon-flavored hydrocodone.

Note: Pain medicine isn't intended to *cause* pain.

The dose she gave me went down my throat for the most part, but a bit of it backwashed and tried to climb up into my sinuses. Neither direction handled things very well - think having a blowtorch fired at your uvula. One coughing fit later, I told her in a voice flavored with misery that there was no way I'd be able to take any more doses of the mixture she'd brought home. She huffed and did her best to keep me from realizing she was pissed at me, and then set out to trade the lemon-flavored lava for regular hydrocodone elixir, no incendiary flavor added.

She went back to the pharmacy that filled the scrip, only to find that it closed early because it was a Saturday. She did eventually get the prescription swapped, but only after driving 30 minutes to the only 24-hour branch of that particular pharmacy and doing god knows how much pleading to get them to transfer the prescription and reissue it in its normal nasty-tasting state. I have no idea exactly how long this took, because I had again passed out on the same spot of the sofa.

I spent most of the rest of the night without moving from that spot. She brought an alarm clock into the living room so that she could sleep on the other part of the sofa and still be able to give me the pain medicine at the proper times.

My memories for the rest of the night and most of Sunday are a bit hazy, but there are a few incidents that I can recall with extreme clarity. Unfortunately, some of these involve some basic bodily input/output functions, so if you don't like that sort of stuff you might want to skip over the next update when it gets posted.

The Operation

The gastric bypass operation took place on Friday, December 11, 2009.  Pre-op was pretty uneventful.  They put an IV in me, and I told the anaesthesiologist about problems I'd had before with nausea and with surpressed breathing response during recovery.  My wife came into the pre-op room and checked on me, then the nurses wheeled me away.

I don't remember anything about the operation, and I don't remember much of the recovery room.  I remember being groggy, and I remember having a urinary catheter and some other tubes sticking out of me.  Everything else is a blur, until some point later in the day when I found myself in my hospital room.

The uneventfulness continued through Saturday until a couple of hours before my discharge from the hospital.  I was still in pain, but I didn't feel like it was unusually bad pain.  I remember telling a nurse that I felt like I was about to have an anxiety attack.  They gave me something for it, and I calmed down shortly afterward.  No one thought that anything out of the ordinary was going on.

The problem is that something very bad was happening inside of me.  Things would get much, much worse within the next 24 hours.

Bad Omens

Okay, so the first doctor was a washout.  Fine, just find another doctor, right?  Sign up for his monthly pre-op orientation session, go, and get the ball rolling again.

It wasn't that easy.

I signed up for doctor #2's orientation session online.  The class was scheduled a couple of hours before I had to go to work (I've done a 9:00 p.m. to 5:00 a.m. airshift for years now).  I show up, and there's a note on the door - the meeting's been cancelled.  No warning, no phone call, no e-mail - just cancelled, no reason given.

The next day I called the doctor's office and rescheduled things.  Turns out I didn't need to go to his orientation session since I'd been to one when I was still considering doctor #1.  That'll teach me to deal with a doctor over the Internet - do it by voice, so you'll know who to yell at next time.

By the latter part of 2009 I was finally getting things squared away for my bypass.  I'd met the bypass doctor, got cardiac approval, had the psychiatric and other counseling done, got insurance approval, and was just waiting for a final appointment with the surgeon prior to the operation.  I was in a bit of a hurry at this point since the end of the year was fast approaching and my insurance deductible would soon re-set.  The Gods of Scheduling must have known this, because it seemed like there was a delay at every possible point.  Even that final pre-op session with the doctor was rescheduled to another day, just hours before the appointment time.

I'd considered myself lucky to have made it through the mindfields of dealing with doctors, hospitals, and insurance companies, but contrary to how I felt, my luck was running out.

Come the day of the pre-op doctor's appointment and my wife and I were sitting in the exam room, talking with the surgeon.  I was on an examination table that was rather high off the ground, and I had taken my glasses case out of my pocket and was holding them for some reason I can't recall.  Somehow I managed to drop them onto the floor on the right side of the table.  I bent over to retrieve them, and right as I got my arm to the floor I felt something go *POP* on the lower right-hand side of my rib cage.  This was followed by a pretty good dose of pain.  I had either pulled a rib cage muscle or done some damage to the cartilage between the ribs, but for some reason the surgeon didn't seem too concerned.  The pain would stay with me for the next four weeks and would impede my recovery, but I didn't know that at the time.

I should have recognized right there that I'd been getting bad omens for weeks.  I didn't even want to consider it, though - I was determined to get the gastric bypass, and I wasn't about to get superstitious before the operation.

Shows you what I know about superstitions, I guess.

(To be continued...)

What Came Before

Allow me to present a brief bit of backstory before I get into the tale of said disasters.  I first broached the subject of a gastric bypass to my wife in the spring of 2009.  She had just recovered from major surgery that had put us near our health insurance policy's catastrophic limit for the year, meaning I could get the operation and have it covered at close to 100%.  She thought this was a good idea, so I began looking into the matter.

The research and scheduling process took quite a while, partly due to work schedule issues, partly due to my own procrastination, but mostly due to red tape.  I had to start over at one point since the doctor I initially chose was a "participating provider" (i.e., one the insurance company would cover in full), but the hospital he worked out of was not.  I finally found what I thought was the right combination of doctor and hospital, but it took most of the rest of the year to do so.  The surgery was set, with only a couple of weeks to spare before a new insurance year began.

BE WARNED:  If you plan on getting a bypass or any other gastric surgery, allow yourself plenty of time.  You'll have to go through more screening processes than you ever thought possible, fill out enough paperwork to sink a ship, and deal with so many nurses, office assistants, and other administrative personnel you'd think you were being audited.  Do yourself a favor and type out as much of your medical information as you can in advance.  That way, you can just put "see attached" on the forms you'll receive.

(To be continued...)

Introductions Are In Order

Hello - my name is Lee Jackson, and I have a bit of a story to share.  It involves a bit of drama, a bit of comedy, a touch of cruel irony, and a huge chunk of physical pain.  It's complicated, to the point where it could be considered by some to be embellished or even made up.  Nevertheless, I swear it is true, from the start to wherever the finish may happen.

I will be changing names here and there to protect the innocent (especially myself and my family, mainly from lawsuits), but I will not be changing any of the facts to the best of my knowledge.  Granted, I may be a bit hazy on some of the facts, but on those points I will bring in my wife to confirm what actually happened.

The story begins on December 11th, 2009 at a certain hospital in the city of Dallas, Texas, where I had what was supposed to be a routine gastric bypass operation to help me lose weight.  What followed was anything but routine.

(To be continued...)